Section 87.211 - Referrals to Other HHS Offices or Other Entities(a) If a consumer or the consumer's LAR contacts OMCAT seeking information or wishing to complain about an HHS program other than Medicaid, the consumer or the consumer's LAR is transferred to OO staff that handle complaints regarding those programs. OMCAT staff inform the consumer or the consumer's LAR of this referral and document it in the HEART system.(b) In accordance with the requirement at 42 CFR § 438.408(f)(1) that a fair hearing related to managed care is only available after an MCO appeal, a request for a fair hearing is referred to the consumer's MCO so it can be submitted to HHSC Appeals Division staff. A request for an appeal of a decision by an MCO is referred to that MCO. OMCAT staff inform the consumer or the consumer's LAR of these referrals and document them in the HEART system.(c) A request from a Medicaid health care provider that does not relate to a consumer's Medicaid case is referred to the HHSC office designated to receive these complaints, in accordance with the Texas Medicaid Provider Procedures Manual maintained by HHSC Medicaid program staff and available on the HHS web site. OMCAT staff inform the health care provider of this referral and document it in the HEART system.26 Tex. Admin. Code § 87.211
Adopted by Texas Register, Volume 44, Number 02, January 11, 2019, TexReg 259, eff. 1/10/2019; Amended by Texas Register, Volume 47, Number 50, December 16, 2022, TexReg 8274, eff. 12/21/2022